| NPI | 1508291436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCAS GARDNER BINGHAM Dermatologist 801-830-7222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A104512) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2018-10-23 |